Munchausen Syndrome by Proxy (cont.)

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are causes/risk factors for Munchausen syndrome by proxy?

Although there is no specific cause for MSBP, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). Little is known about the specific biological vulnerabilities from which individuals with MSBP are more likely to suffer. Psychologically, MSBP perpetrators tend to have trouble forming a healthy bond (attachment) with their children. Personality traits of individuals who have a history of inducing symptoms in the children they care for include difficulty managing anger or frustration, as well as the characteristic of the perpetrator of having to overcome the urge to protect and prevent abuse of loved ones. Socially, perpetrators tend to be more likely to have suffered from some sort of major negative event (trauma) during their own childhood, including the death of a parent or having been themselves the victim of child abuse or neglect.

What are the signs and symptoms of Munchausen syndrome by proxy?

In the diagnostic manual that is recognized by most mental-health professionals, The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, treatment revision, MSBP is classified as a factitious disorder, not otherwise specified. Symptoms include the sufferer being induced to experience physical or psychological symptoms or to have symptoms fabricated by another, usually a caretaker. Specific symptoms in the victim are nearly as varied as the number of victims and perpetrators, with perhaps more emphasis on symptoms that are more feasibly manufactured or induced or are more difficult to measure objectively through laboratory tests (for example, stomach upset, other body aches and pains, trouble breathing or sleeping). Some more common symptoms presented by victims of MSBP include suffocation, induced seizures, bleeding, or poisoning that presents as vomiting or diarrhea. The abusive parent may describe symptoms in their child that do not exist. The symptoms may get worse only when the suspected caretaker is present or recently visited and may improve when the perpetrator is absent. Theories on what motivates the adult who assumes the sick role by causing a child to be sick might fall into one of three categories of motivation: help seeking, active induction of symptoms, and "addiction" to interactions with doctors. The help seeker is thought to be motivated to fabricate or cause their child's illness as a way of getting help for him or herself, assuming the sick role through their association with the supposedly sick child. This may be due to their feeling overwhelmed by their marriage, parenthood, or their own physical or emotional problems. The parent who actively induces symptoms of MSBP in the victim is thought to be seeking control of the medical professionals, as well as wanting recognition as an excellent parent by the professionals. Perpetrators who seem to be addicted to doctors are thought to be motivated to be seen as knowing better than the doctors.